PHI stands for "Protected Health Information" (Y = Yes, N = No)
| Display | Field | Phi | Field type | Condition choices | Field note | Header | |
|---|---|---|---|---|---|---|---|
| 1. In general, would you say your health is: | rand36_1 | N | radio | 100, 1 Excellent | 75, 2 Very good | 50, 3 Good | 25, 4 Fair | 0, 5 Poor | - | - | |
| 2. Compared to one year ago, how would your rate your health in general now? | rand36_2 | N | radio | 100, 1 Much better now than one year ago | 75, 2 Somewhat better now than one year ago | 50, 3 About the same | 25, 4 Somewhat worse now than one year ago | 0, 5 Much worse now than one year ago | - | - | |
| 3a. Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports | rand36_3 | N | radio | 0, 1 Yes, limited a lot | 50, 2 Yes, limited a little | 100, 3 No, not limited at all | - | 3. The following items are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? (Choose one answer for each question.) | |
| 3b. Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf | rand36_4 | N | radio | 0, 1 Yes, limited a lot | 50, 2 Yes, limited a little | 100, 3 No, not limited at all | - | - | |
| 3c. Lifting or carrying groceries | rand36_5 | N | radio | 0, 1 Yes, limited a lot | 50, 2 Yes, limited a little | 100, 3 No, not limited at all | - | - | |
| 3d. Climbing several flights of stairs | rand36_6 | N | radio | 0, 1 Yes, limited a lot | 50, 2 Yes, limited a little | 100, 3 No, not limited at all | - | - | |
| 3e. Climbing one flight of stairs | rand36_7 | N | radio | 0, 1 Yes, limited a lot | 50, 2 Yes, limited a little | 100, 3 No, not limited at all | - | - | |
| 3f. Bending, kneeling, or stooping | rand36_8 | N | radio | 0, 1 Yes, limited a lot | 50, 2 Yes, limited a little | 100, 3 No, not limited at all | - | - | |
| 3g. Walking more than a mile | rand36_9 | N | radio | 0, 1 Yes, limited a lot | 50, 2 Yes, limited a little | 100, 3 No, not limited at all | - | - | |
| 3h. Walking several blocks | rand36_10 | N | radio | 0, 1 Yes, limited a lot | 50, 2 Yes, limited a little | 100, 3 No, not limited at all | - | - | |
| 3i. Walking one block | rand36_11 | N | radio | 0, 1 Yes, limited a lot | 50, 2 Yes, limited a little | 100, 3 No, not limited at all | - | - | |
| 3j. Bathing or dressing yourself | rand36_12 | N | radio | 0, 1 Yes, limited a lot | 50, 2 Yes, limited a little | 100, 3 No, not limited at all | - | - | |
| 4a. Cut down the amount of time you spent on work or other activities | rand36_13 | N | radio | 0, 1 Yes | 100, 2 No | - | 4. During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of your physical health? (Choose one answer for each question.) | |
| 4b. Accomplished less than you would like | rand36_14 | N | radio | 0, 1 Yes | 100, 2 No | - | - | |
| 4c. Were limited in the kind of work or other activities | rand36_15 | N | radio | 0, 1 Yes | 100, 2 No | - | - | |
| 4d. Had difficulty performing the work or other activities (for example, it took extra effort) | rand36_16 | N | radio | 0, 1 Yes | 100, 2 No | - | - | |
| 5a. Cut down the amount of time you spent on work or other activities | rand36_17 | N | radio | 0, 1 Yes | 100, 2 No | - | 5. During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)? (Choose one answer for each question.) | |
| 5b. Accomplished less than you would like | rand36_18 | N | radio | 0, 1 Yes | 100, 2 No | - | - | |
| 5c. Didn't do work or other activities as carefully as usual | rand36_19 | N | radio | 0, 1 Yes | 100, 2 No | - | - | |
| 6. During the past 4 weeks, to what extent has your physical health or emotional problems interfered with your normal social activities with family, friends, neighbors, or groups? (Choose one answer.) | rand36_20 | N | radio | 100, 1 Not at all | 75, 2 Slightly | 50, 3 Moderately | 25, 4 Quite a bit | 0, 5 Extremely | - | - | |
| 7. How much bodily pain have you had during the past 4 weeks? (Choose one answer.) | rand36_21 | N | radio | 100, 1 None | 80, 2 Very mild | 60, 3 Mild | 40, 4 Moderate | 20, 5 Severe | 0, 6 Very severe | - | - | |
| 8. During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)? (Choose one answer.) | rand36_22 | N | radio | 100, 1 Not at all | 75, 2 A little bit | 50, 3 Moderately | 25, 4 Quite a bit | 0, 5 Extremely | - | - | |
| 9a. Did you feel full of life? | rand36_23 | N | radio | 100, 1 All of the time | 80, 2 Most of the time | 60, 3 A good bit of the time | 40, 4 Some of the time | 20, 5 A little of the time | 0, 6 None of the time | - | 9. These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling._x000D_ _x000D_ How much of the time during the past 4 weeks . . .(Choose one answer for each question.) | |
| 9b. Have you been a very nervous person? | rand36_24 | N | radio | 0, 1 All of the time | 20, 2 Most of the time | 40, 3 A good bit of the time | 60, 4 Some of the time | 80, 5 A little of the time | 100, 6 None of the time | - | - | |
| 9c. Have you felt so down in the dumps that nothing could cheer you up? | rand36_25 | N | radio | 0, 1 All of the time | 20, 2 Most of the time | 40, 3 A good bit of the time | 60, 4 Some of the time | 80, 5 A little of the time | 100, 6 None of the time | - | - | |
| 9d. Have you felt calm and peaceful? | rand36_26 | N | radio | 100, 1 All of the time | 80, 2 Most of the time | 60, 3 A good bit of the time | 40, 4 Some of the time | 20, 5 A little of the time | 0, 6 None of the time | - | - | |
| 9e. Did you have a lot of energy? | rand36_27 | N | radio | 100, 1 All of the time | 80, 2 Most of the time | 60, 3 A good bit of the time | 40, 4 Some of the time | 20, 5 A little of the time | 0, 6 None of the time | - | - | |
| 9f. Have you felt downhearted and blue? | rand36_28 | N | radio | 0, 1 All of the time | 20, 2 Most of the time | 40, 3 A good bit of the time | 60, 4 Some of the time | 80, 5 A little of the time | 100, 6 None of the time | - | - | |
| 9g. Did you feel worn out? | rand36_29 | N | radio | 0, 1 All of the time | 20, 2 Most of the time | 40, 3 A good bit of the time | 60, 4 Some of the time | 80, 5 A little of the time | 100, 6 None of the time | - | - | |
| 9h. Have you been a happy person? | rand36_30 | N | radio | 100, 1 All of the time | 80, 2 Most of the time | 60, 3 A good bit of the time | 40, 4 Some of the time | 20, 5 A little of the time | 0, 6 None of the time | - | - | |
| 9i. Did you feel tired? | rand36_31 | N | radio | 0, 1 All of the time | 20, 2 Most of the time | 40, 3 A good bit of the time | 60, 4 Some of the time | 80, 5 A little of the time | 100, 6 None of the time | - | - | |
| 10. During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)?_x000D_ _x000D_ (Choose one number) | rand36_32 | N | radio | 0, 1 All of the time | 25, 2 Most of the time | 50, 3 Some of the time | 75, 4 A little of the time | 100, 5 None of the time | - | - | |
| 11a. I seem to get sick a little easier than other people | rand36_33 | N | radio | 0, 1 Definitely true | 25, 2 Mostly true | 50, 3 Don't know | 75, 4 Mostly false | 100, 5 Definitely false | - | 11. How TRUE or FALSE is each of the following statements for you. _x000D_ _x000D_ (Choose one number for each question.) | |
| 11b. I am as healthy as anybody I know | rand36_34 | N | radio | 100, 1 Definitely true | 75, 2 Mostly true | 50, 3 Don't know | 25, 4 Mostly false | 0, 5 Definitely false | - | - | |
| 11c. I expect my health to get worse | rand36_35 | N | radio | 0, 1 Definitely true | 25, 2 Mostly true | 50, 3 Don't know | 75, 4 Mostly false | 100, 5 Definitely false | - | - | |
| 11d. My health is excellent | rand36_36 | N | radio | 100, 1 Definitely true | 75, 2 Mostly true | 50, 3 Don't know | 25, 4 Mostly false | 0, 5 Definitely false | - | - | |
| Notes | rand_36_item_sf_health_surveyform_notes | Y | notes | - | - | - |